Acne vulgaris

Question 1

pathophysiology

Answer 1

1. increased androgens in puberty
2. increased sebum and keratin production in sebaceous glands
3. keratin plugs pilosebaceous units = comedones (blackheads/whiteheads)
4. rupture of comedones = inflammation and granulomas
5. infection with anaerobic bacteria

Question 2

presentation (4 + 3 location)

Answer 2

comedones (blackheads/whiteheads) = precursor of acne
pustules and papules (small red spots)
erythema
scars (secondary feature)

location - face, upper back, anterior chest (= where the sebaceous glands are)

Question 3

grading (mild, moderate, severe)

Answer 3

Mild – scattered pustules and papules, comedones
Moderate – numerous plaques, pustules, mild atrophic scarring
Severe – cysts, nodules, significant scarring

Question 4

first line treatment (4)

Answer 4

lifestyle changes - change skin care (avoid oily substances), stop smoking/drinking, change diet

oral contraceptive pill (females only)

Question 5

second line treatment after lifestyle change (2)

Answer 5

topical treatment;

topical retinoid +/- benzoyl peroxide (keratolytic if pustules present)
topical antibiotics

Question 6

third line treatment after topical treatment (2)

Answer 6

systemic treatment - 
PO antibiotics (eg doxycycline, clindamycin, erythromycin) + topical retinoid

Question 7

forth line treatment after PO antibiotics

Answer 7

PO retinoid (eg isotretinoin)

Question 8

side effects of isotretinoin

Answer 8

decreased vit A, decrease sebaceous gland activity = dry skin, PREGNANCY CONTRAINDICATED, suicidal thoughts

Question 9

which age group typically present with acne

Answer 9

teenagers

Question 10

what do you prescribe if pustules present

Answer 10

benzoyl peroxide